While numerous states have enacted legislation that limits women’s access to abortions through 24-hour waiting periods, reduced Medicaid funding, and compulsory ultrasounds, the most effective measures for undermining women’s choice may be a new crop of supply-side laws that focus on lowering the number of providers of abortion services, Theodore Joyce argues in the New England Journal of Medicine. Kansas and Virginia, for instance are leading the way in regulating providers out of existence through new licensing requirements for room sizes, staffing, and other physical specifics and may soon serve as a template for red governors hoping to effectively ban abortions in their states.

Joyce studied the impact of a 2004 Texas law which instituted a 24-hour waiting period for all abortions and required “abortions at or after 16 weeks of gestation be performed in a hospital or an ambulatory surgical center.” He found that while the supply-side restriction had “dramatic effects,” the demand-side 24-hour waiting period “had none“:

The number of abortions performed in Texas at or after 16 weeks of gestation dropped by 88%, from 3642 in 2003 to 446 in 2004, while the number of residents who left the state for a late abortion almost quadrupled, from 187 in 2003 to 736 in 2004. Despite this large outflow, there were 2460 fewer abortions at 16 weeks or later in Texas residents 1 year after the law took effect, a 68% decline. By 2006, Austin, Dallas, Houston, and San Antonio had ambulatory surgical centers in which abortions were performed at or after 16 weeks of gestation, but the number of such abortions remained well below the 2003 level. Over the same period there was no meaningful change in the number of abortions before 16 weeks of gestation. The demand-side policies had no measurable impact.

Supply-side laws significantly impact access for lower-income women who lack the means to travel to states with less restrictive policies. “Thus, if a ‘blue state–red state’ distribution of abortion services evolves,” Joyce warns, “the pre-Roe racial and socioeconomic patterns will probably reemerge. Women with resources will travel substantial distances for an abortion, whereas less-advantaged women will travel less.”

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